Did you know that a fractured tooth can go unnoticed until it gets infected? Learn about its symptoms, types, causes, and treatment options.
Crown and root are the two parts of a tooth. The root is made up of two hard tissues, enamel and dentin, and the root has dentin and cementum. The center of the tooth (root canal) consists of soft pulp, which contains the nerves and blood vessels. A fracture can include enamel, dentin, cementum, or pulp.
source : wilkdental
While chewing on hard foods, a tooth can fracture or crack. It is also commonly seen in people who grind their teeth at night, play contact sports, or it can occur spontaneously in older adults. It is one of the commonest tooth condition that results in tooth loss.
There are various treatment options available to save a cracked tooth. Unlike a broken bone, a fractured tooth will never be 100 % healed even after treatment, but getting it treated will prevent further damage and spread of infection.
You can protect your teeth by maintaining good oral hygiene, avoid biting on hard foods, and wearing a mouthguard. In most cases, the crack can be seen, but sometimes if the fracture is along the length of the tooth, it is impossible to see them with the naked eye. If you cannot see the fracture, certain symptoms like pain while chewing or sudden sensitivity to hot and cold can be signs of it.
Very small fractures are difficult to diagnose, as it might not cause any symptoms except for pain that occurs on and off. Prompt treatment should be sought after because if left untreated, it can cause severe pain, infection, and tooth loss.
Craze lines - They are minute cracks in the enamel of a tooth. They usually do not result in any pain and need no treatment.
Fractured cusp - It is the fracture of the pointy part of the biting surface of a tooth (cusp). It commonly occurs around a tooth filling and does not involve the pulp. As a result, it does not result in much pain.
Cracked tooth - This type of fracture runs vertical and usually extends into the gum line. If the fracture has not reached the gum line (incomplete crown fracture), the prognosis is good. But the tooth might have to be extracted of the crack extends into the gum line (incomplete crown-root fracture).
Split tooth - It is when the two fractured segments can be separated. Depending on the extent of fracture, the dentist might save one segment of the tooth or extract the entire tooth.
Vertical root fracture - Here, the fracture starts below the gum line and then travels up. It does not cause any symptoms until the tooth gets infected. Usually, such teeth need to be extracted.
source : microendocenter
The common causes of a tooth fracture are:
Bitting on hard food items.
Grinding the teeth at night (bruxism).
Increasing age (above 50 years).
A tooth that has a large dental filling, as it weakens the tooth.
Injury to the chin or jaw during road traffic accidents, contact sports, fall, etc.
Eating something very cold immediately after eating something hot might cause fractures due to temperature change.
Root fractures are commonly seen in people with gum diseases.
Most people do not have any symptoms. Craze lines do not cause any symptoms and do not require treatment. Severe cases results in the following symptoms:
Pain while chewing or biting.
Pain occurs on and off.
Tooth sensitivity to sweet foods.
Tooth feels sensitive to hot and cold foods.
Most of the time, a minor tooth fracture is accidentally diagnosed in an x-ray taken for some other condition. Sometimes fractures do not show up in an x-ray also, this is due to the angle at which the x-ray was taken and the type of fracture.
A dentist will take a complete medical and dental history, and ask you if you chew a lot of hard food or grind your teeth at night. If needed, the dentist might use a magnifying lens or dental dye to look for any cracks.
Your dentist might also ask you to bite on something hard. You might have pain when you release your bite if your tooth is cracked.
Depending on your symptoms, location and size of the fracture, various treatment options are available. Your dentist might suggest one of the following treatment modalities:
1) Bonding or dental filling - If the fracture does not involve the pulp or dentin, the dentist fills the crack using tooth-colored composite resin. In this method, the doctor will etch the surface to make it rough, so the bonding material adheres to the tooth. Then the tooth-colored resin is used to build the fractured part of the tooth, and the material is hardened using ultraviolet light.
2) Dental crown or cap - When the fracture involves the dentin or a lot of tooth portion is lost, then a dental crown or cap is used to cover the damaged tooth. It is tooth-shaped and can be made from metal, metal and ceramic, or all ceramic. It is fitted over the fractured tooth and makes is functionally and aesthetically better. The dentist will first cut the tooth to make space for the dental crown and make an impression, which is sent to the lab. The lab will fabricate the crown depending on the patient’s bite and tooth color.
3) Root canal treatment - If the crack is extensive and it involves the pulp or if it has resulted in the infection of the pulp, then root canal treatment is necessary. Here, the infected pulp in the root canal is removed and the root canal is shaped and prepared. Then the root canal is filled with a biocompatible material and a dental crown is placed on the tooth to increase strength and appearance.
4) Extraction - Your dentist will extract the tooth only if the tooth is damaged beyond repair.
Craze lines and other hairline cracks in the enamel do not cause any symptoms and need no treatment.
The complications of a fractured tooth are:
Pain on biting.
Swollen glands in the neck.
To prevent this condition, avoid biting on hard foods, maintain good oral hygiene, and ask your dentist for a mouthguard. For more information, consult a dentist online.
If the fracture has been extended only until the tooth’s pulp, the tooth can be treated with the help of a root canal procedure, and a crown can be used to protect the crack from spreading further. However, if the crack has extended below the gums already, it is no longer treatable, and the tooth can’t be saved, and it should be extracted.
Yes, a fractured tooth can heal on its own, provided the fracture is minimal. It includes those fractures that involve only the outer levels of the tooth. This self-healing process of a tooth is called remineralization. Severe forms of fractures cannot be healed.
The following are the signs and symptoms of a fractured tooth.
- Pain when chewing or biting, especially when the person releases the bite.
- Extreme sensitivity to heat, cold, or sweet foods.
- Pain that comes and goes but is rarely progressive.
- Swelling of the gum and redness, particularly around the affected tooth.
Most fractured teeth can be repaired by the reattachment of the broken piece of tooth enamel or by bonding an artificial tooth-colored filling or an artificial crown in place. It can also be treated by using a root canal procedure.
A fracture can be repaired surgically by a dentist, but a fractured tooth cannot be healed completely. It can be restored aesthetically. But, immediate treatment provides the best chance of saving the individual’s fractured tooth and preventing infection that can lead to further damage.
Usually, a broken or fractured tooth is not a dental emergency. It is an emergency only when the patient is experiencing excruciating pain or profuse bleeding. A trauma caused by accidents might cause skull fractures also along with teeth fracture, so in those cases, the patient should immediately seek medical care.
If the tooth fracture is very minimal, involving only the crown region, it usually does not cause any complications. But, when it consists of the gums or the other associated facial structures, patients may have severe pain, and infections might develop. The infections could be so severe that it can even spread to the brain known as meningitis.
X-rays commonly do not elicit the small fractures that are known to cause cracked tooth syndrome. Only if the fractures are wide enough, they might be shown up as shadows in the X-ray. Sometimes a special dye might be frequently used to stain the affected tooth temporarily, and look if it is fractured or not.
If a tooth that is fractured is causing pain, it is a very serious condition, and it usually requires a crown. The fracture in a cracked tooth will not heal like other bones in the body. Vertical cracks in the tooth that travels up to the gums will require a full-coverage crown.
A fractured tooth can be easily visible if it is wide. In those cases, there can be additional symptoms like severe pain, swelling of the gums, redness, visible bleeding, etc. Still, if the fracture is minimal, most patients fail to notice it immediately. They notice it later only when there is some difficulty in their mastication.
The following are certain ways you can provide the necessary first aid to a fractured tooth at home. It is important for you to understand that it is not the definitive cure, and once the first aid is done, you should seek medical care immediately.
- If your whole tooth is fractured and falls off with the root intact, try to place it in a small container with milk and rush to the dentist.
- If the remaining tooth apart from the fractured piece has a sharp edge, you can cover it with things like chewing gum, gauze, or wax.
- If you are experiencing excruciating pain, try taking over-the-counter pain relievers.
If a cracked tooth is left untreated, it might get into severe complications. It can cause severe infections that are capable of spreading to the surrounding structures. It can especially spread to the brain and cause meningitis. Sometimes, a cracked tooth can be easily treated by a dentist, but permanent damage to the tooth can occur when it is not treated.
Teeth injuries are usually very painful. The pain can limit the affected person’s routine activities like eating, speaking, and sleeping. The affected part of the face can also be severely swollen and red that it is apparently visible. It is because of the increased number of sensory nerve supplies to the teeth.
The following are some ways how you can temporarily fix a broken tooth.
- If the tooth pain is so severe, take Acetaminophen, Ibuprofen, or any other over-the-counter pain medicines.
- If the fracture has caused a sharp or jagged edge on the affected tooth, cover it gently with a piece of wax paraffin or any sugarless chewing gum, since sugars can increase sensitivity and aggravate the pain. This also prevents the fractured teeth from cutting your tongue or any parts of your oral cavity.
If you have to eat, then go for soft foods and sugarless drinks alone.
After temporarily fixing the fractured tooth, always seek immediate medical care to prevent permanent damage.
If the fractured tooth seems dirty, rinse it only with milk or a saline solution. It is necessary to keep it back into its empty socket in your mouth as early as possible and rush to a dentist. Do not use water or alcohol to rinse the fractured piece of tooth. You can also fix a broken tooth by biting clean material such as cotton cloth or a wet tea bag. This will help in holding the teeth in its place.
Yes, a fractured tooth is not a life-threatening condition. People can lead their healthy lives by treating it with a root canal procedure or removing it surgically.
There are five classes of fracture according to Bennet’s classification of tooth fractures. Those are as follows:
Class I – Traumatized tooth without coronal or
a) A tooth from the alveolus.
b) Tooth subluxated in the alveolus.
Class II – Coronal fracture.
a) Involving enamel.
b) Involving enamel and dentin.
Class III – Coronal fracture with pulpal exposure.
Class IV – Root fracture.
a) Without coronal fracture.
b) With coronal fracture.
Class V – Avulsion of the tooth.
Yes, sometimes, an excess pressure applied on a tooth during root canal procedure may cause a fracture. After a root canal treatment, usually, the teeth become very brittle, and they are more susceptible to cracked tooth syndrome than normal teeth.
A fracture in a root canal tooth is also considered the same as a normal fracture. If the fracture is extended beneath the gums, it can be treated.
The treatment of broken teeth usually depends on the severity and depth of the fracture. It will also depend on the comorbidities of the patient like diabetes, which are risk factors to certain modes of treatment. The following are specific methods of treating a broken tooth.
- Dental implant.
- Root canal.
- Dental filling.
- Dental sealants.
Last reviewed at:
21 Oct 2019 - 5 min read
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